Transarterial embolization of the external carotid artery in the treatment of life-threatening haemorrhage following blunt maxillofacial trauma

Autor: Tomislav Mirkovic, Crt Langel, Katarina Surlan Popovic, Anita Mrvar-Brečko, Primoz Gradisek, Ursa Zabret, Dimitrij Lovric
Rok vydání: 2020
Předmět:
medicine.medical_specialty
medicine.medical_treatment
External carotid artery
R895-920
Poison control
Context (language use)
Hemorrhage
Review
Anastomosis
Wounds
Nonpenetrating
external carotid artery injury
030218 nuclear medicine & medical imaging
03 medical and health sciences
Medical physics. Medical radiology. Nuclear medicine
0302 clinical medicine
medicine.artery
Medicine
Humans
Radiology
Nuclear Medicine and imaging
Embolization
Survival rate
precipitating hydrophobic injectable liquid
neurointervention
business.industry
blunt maxillofacial trauma
non-adhesive liquid embolization agent
Glasgow Coma Scale
Embolization
Therapeutic
intractable bleeding
Surgery
Oncology
Carotid Artery
External
Injury Severity Score
Maxillofacial Injuries
business
Carotid Artery Injuries
030217 neurology & neurosurgery
Zdroj: Radiology and Oncology
Radiology and Oncology, Vol 54, Iss 3, Pp 253-262 (2020)
ISSN: 1581-3207
Popis: Background Severe bleeding after blunt maxillofacial trauma is a rare but life-threatening event. Non-responders to conventional treatment options with surgically inaccessible bleeding points can be treated by transarterial embolization (TAE) of the external carotid artery (ECA) or its branches. Case series on such embolizations are small; considering the relatively high incidence of maxillofacial trauma, the ECA TAE procedure has been hypothesized either underused or underreported. In addition, the literature on the ECA TAE using novel non-adhesive liquid embolization agents is remarkably scarce. Patients and methods PubMed review was performed to identify the ECA TAE literature in the context of blunt maxillofacial trauma. If available, the location of the ECA injury, the location of embolization, the chosen embolization agent, and efficacy and safety of the TAE were noted for each case. Survival prognostic factors were also reviewed. Additionally, we present an illustrative TAE case using a precipitating hydrophobic injectable liquid (PHIL) to safely and effectively control a massive bleeding originating bilaterally in the ECA territories. Results and conclusions Based on a review of 205 cases, the efficacy of TAE was 79.4–100%, while the rate of major complications was about 2–4%. Successful TAE haemostasis, Glasgow Coma Scale score ≥ 8 at presentation, injury severity score ≤ 32, shock index ≤ 1.1 before TAE and ≤ 0.8 after TAE were significantly correlated with higher survival rate. PHIL allowed for fast yet punctilious application, thus saving invaluable time in life-threatening situations while simultaneously diminishing the possibility of inadvertent injection into the ECA-internal carotid artery (ICA) anastomoses.
Databáze: OpenAIRE
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